Combined aromatherapy and music or sound for emotional distress: a systematic review of controlled studies published between 2019 and 2026.
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BACKGROUND: Emotional distress is common around clinical procedures, cancer supportive care, and health-professions training. Aromatherapy and music are easy to deliver, yet it remains unclear when combining them is worthwhile and whether the combination offers more than either component alone. OBJECTIVE: To synthesize experimental studies of aromatherapy combined with music or sound published from January 2019 through September 7, 2026; identify the populations and settings in which benefits were most consistent; and separate benefit over inactive care from incremental benefit over a single sensory intervention. METHODS: We searched PubMed, Embase, CINAHL, APA PsycINFO, Scopus, Web of Science Core Collection, CENTRAL, CNKI, and Dentistry & Oral Sciences Source from January 1, 2019, to September 7, 2026. Randomized trials and controlled nonrandomized or quasi-experimental studies were eligible when they included an identifiable arm combining aromatherapy with music or sound and reported emotional-distress or related physiological outcomes. Two reviewers independently screened records, extracted data, and assessed risk of bias. Clinical and methodological heterogeneity precluded meta-analysis; findings were synthesized narratively using SWiM guidance. RESULTS: Twenty-four studies involving 2,530 participants from 12 countries or regions were included. Of these, 21 were randomized studies and three were controlled nonrandomized or quasi-experimental studies. The evidence covered procedural and perioperative care, dentistry, nursing education and occupational stress, and cancer or palliative care. Results were most consistent in pediatric dentistry, magnetic resonance imaging, nursing examinations or skills testing, and some repeated cancer-support programs. Two lithotripsy trials and the adult endodontic study did not show a clear benefit. Although combined treatment often outperformed inactive care, it frequently failed to outperform aromatherapy or music alone. Adverse events, acceptability, and economic outcomes were poorly reported. CONCLUSION: Combined aromatherapy and music or sound showed the most consistent reductions in anxiety or distress in pediatric dentistry, MRI examinations, nursing examinations or skills training, and some perioperative and cancer-support settings. Clear benefit was not demonstrated in lithotripsy or endodontic care; in general surgery, pregnancy non-stress testing, coronary angiography, palliative care, and outpatient oncology, the combination generally did not outperform a single modality. Future adequately powered factorial trials should standardize the interventions and use prespecified between-group comparisons, longer follow-up, and systematic reporting of adverse events and costs. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD42024570691, CRD42024570691.